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Organ Donation

Question Type:
Intervention
Full Question:
In adults and children who are receiving an organ transplant in any setting  (P), does do organs retrieved from a donor who has had CPR  (I), compared with compared with organs retrieved from a donor who did not have CPR  (C), change increase survival rates, Complication Rate (O)?
Consensus on Science:
Donors With Prior CPRTwo nonrandomized studies provided low-quality evidence that the mean yield of organs procured from donors who had been resuscitated by CPR before donation was 3.9(Faucher 2014, 42) or 2.9.(Orioles 2013, 2794) For the important outcome of immediate graft survival, low-quality evidence from nonrandomized studies did not detect any worse outcome when donors have had CPR and resuscitation for adult hearts (3239 organs(Hsu 1999, 663; Ali 2007, 929; Adrie 2008, 132; Sanchez-Lazaro 2010, 3091; Pilarczyk 2011, 342; Orioles 2013, 2794; Quader 2013, 1090; Southerland 2013, 312)), pediatric hearts (557 organs, 4 studies), adult lungs (1031 organs (Pilarczyk 2011, 342; Castleberry 2013, 466; Orioles 2013, 2794)), pediatric lungs (105 organs(Orioles 2013, 2794)), adult kidneys (5000 organs(Mercatello 1988, 749; Orioles 2013, 2794)), pediatric kidneys (1122 organs(Finfer 1996, 1424; Orioles 2013, 2794)), adult livers (2911 organs(Adrie 2008, 132; Orioles 2013, 2794)), pediatric livers (689 organs(Finfer 1996, 1424; Orioles 2013, 2794)), adult intestines (25 organs(Matsumoto 2008, 941; Orioles 2013, 2794)), and pediatric intestines (79 organs(Orioles 2013, 2794)).For the important outcome of graft survival for 1 year, low-quality evidence from nonrandomized studies did not detect any worse outcome when donors have had CPR and resuscitation for adult hearts (3230 organs(Ali 2007, 929; Adrie 2008, 132; Pilarczyk 2011, 342; Orioles 2013, 2794; Quader 2013, 1090), (Sanchez-Lazaro 2010, 3091; Southerland 2013, 312)), pediatric hearts (1605 organs(de Begona 1993, 1196; Finfer 1996, 1424; L'Ecuyer 2011, 742; Orioles 2013, 2794)), adult lungs (1031 organs(Pilarczyk 2011, 342; Castleberry 2013, 466; Orioles 2013, 2794)), pediatric lungs (105 organs(Orioles 2013, 2794)), adult kidneys (5000 organs (Adrie 2008, 132; Orioles 2013, 2794)), pediatric kidneys (1122 organs (Orioles 2013, 2794)), adult livers (2911 organs (Adrie 2008, 132; Orioles 2013, 2794)), pediatric livers (689 organs (Orioles 2013, 2794)), adult intestines (25 organs(Matsumoto 2008, 941; Orioles 2013, 2794)), and pediatric intestines (79 organs (Orioles 2013, 2794)).For the important outcome of graft survival for 5 years, low-quality evidence from nonrandomized studies did not detect any worse outcome when donors have had CPR and resuscitation for adult hearts (3230 organs(Ali 2007, 929; Adrie 2008, 132; Sanchez-Lazaro 2010, 3091; Pilarczyk 2011, 342; Orioles 2013, 2794; Quader 2013, 1090; Southerland 2013, 312)), pediatric hearts (1537 organs(L'Ecuyer 2011, 742; Conway 2013, 774; Orioles 2013, 2794)), adult lungs (1031 organs(Pilarczyk 2011, 342; Castleberry 2013, 466; Orioles 2013, 2794)), pediatric lungs (105 organs(Orioles 2013, 2794)), adult kidneys (5000 organs(Adrie 2008, 132; Orioles 2013, 2794)), pediatric kidneys (1122 organs(Orioles 2013, 2794)), adult livers (2911 organs(Adrie 2008, 132; Orioles 2013, 2794)), pediatric livers (689 organs(Orioles 2013, 2794)), adult intestines (25 organs(Orioles 2013, 2794)), and pediatric intestines (79 organs(Orioles 2013, 2794)).Donors With Ongoing CPR (Uncontrolled Non–Heart-Beating Donors or Uncontrolled Donation After Circulatory Death)Two nonrandomized studies provided low-quality evidence that the mean number of organs procured from donors with ongoing CPR was 1.5(Fondevila 2012, 162) and 3.2.(Mateos-Rodriguez 2012, 164)For the important outcome of immediate graft survival, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non–heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (203 organs(Casavilla 1995, 197; Nicholson 2000, 2585; Alonso 2005, 3658; Morozumi 2010, 620)) or adult livers (64 organs(Casavilla 1995, 197; Totsuka 1999, 818; Otero 2004, 747; Fondevila 2012, 162)).For the important outcome of graft survival for 1 year, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non–heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (199 organs(Casavilla 1995, 197-203; Nicholson 2000, 2585; Alonso 2005, 3658)) or adult livers (60 organs(Casavilla 1995, 197; Otero 2004, 747; Fondevila 2012, 162)).For the important outcome of graft survival for 5 years, low-quality evidence from nonrandomized studies did not detect any worse outcome when organs were recovered from non–heart-beating donors with ongoing CPR compared with other types of donors for adult kidneys (177 organs(Nicholson 2000, 2585; Alonso 2005, 3658)) or adult livers (34 organs(Fondevila 2012, 162)).
Treatment Recommendation:
We recommend that all patients who have restoration of circulation after CPR and who subsequently progress to death be evaluated for organ donation (strong recommendation, low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we consider the absence of any evidence of worse graft function from donors with antecedent CPR, the desirability of providing more organs to waiting recipients, and the absence of any risk to the donor. As in all organ donations, the function of the donated organ determines whether procurement and transplantation proceed. Therefore, there is also precaution to ensure the safety of the recipient. We suggest that patients who fail to have restoration of circulation after CPR and who would otherwise have termination of CPR efforts be considered candidates for kidney or liver donation in settings where programs exist (weak recommendation, low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we consider the evidence that kidney grafts obtained from donors in whom CPR failed can function at rates comparable to kidneys obtained from other donors, and that recipients can safely tolerate delayed graft function that is common with kidneys obtained in this manner. We also consider the immediate lifesaving potential of liver grafts, which offsets the potentially greater rate of long-term graft failure in livers obtained from donors with ongoing CPR.
CoSTR Attachments:
AgreementDisagreement_Updated_Reasons_final_n.xlsx    
Copy of ILCORDataCollectionFormOrganDonationFinal_n.xls    
SummarofBiasAssessmentsOrganDonationFinal_n.xlsx    
TableResultsFinal_n.docx    

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